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How to Counsel Patients about Immunizations

In recent years, we’ve made great strides in encouraging vaccination in pregnant women. During the 2009 H1N1 pandemic, influenza vaccination rates in pregnant women increased from 15% to around 47%. Since then, rates have been sustained around 50%, increasing to 53% in the 2013-14 flu season. However, there are still patients who choose not to be vaccinated, possibly due to misinformation about vaccines.

Recently, one of my patients asked my opinion about a publication that questioned the benefits and risks of immunizations. I read the article and recognized it was like other sources of misinformation I have encountered. It was strongly biased and discouraged compliance with our immunization recommendations for pregnant women, and was similarly biased against pediatric immunization schedules.

In my response to this patient, I explained that physicians often balance risk versus benefit. Here is an excerpt:

In medicine, we deal with many unknown risks that are difficult to recognize and quantify. However, we have extensive data on the benefits of vaccines. The information about vaccinations in this article has been strongly refuted by legitimate scientific research. Simply put, any yet-to-be-determined risk of immunization of women during pregnancy, particularly for flu and Tdap, is far outweighed by the risk of maternal and infant death and morbidity. You might recall, we had excessive numbers of pregnant women die from the H1N1 virus during the 2009 epidemic. Those deaths likely could have been prevented by immunization.

I am not suggesting that my answer to this patient’s question is how other obstetricians and gynecologists should answer the same question. How we best communicate with patients is dependent upon multiple factors and will differ from one patient to the next. However, it is our obligation as physicians to tell our patients about the true risks and benefits of immunization. Advice and information from a trusted health care provider play an important role in a patient’s decision to get vaccinated. ACOG’s Immunization for Women website has additional resources on how to communicate with patients.

December 7-13 is National Influenza Vaccination Week, a national campaign to urge everyone to get the flu vaccine. This week, I encourage you to use the “power of the white coat” to positively influence patient decisions. Start conversations with your patients about the importance of the flu vaccine.

About John C. Jennings, MD

John C. Jennings, MD is the president of ACOG through April 2015. He is professor of ob-gyn at the Texas Tech University Health Sciences Center at the Permian Basin. Dr. Jennings was in private practice in San Angelo, TX, for 12 years before entering academic medicine. He has served as head of gynecology and program director of ob-gyn at Wake Forest University in Winston-Salem, NC; professor and program director of ob-gyn at the University of Texas Medical Branch in Galveston; chair and program director of ob-gyn at TTUHSC at Amarillo; and regional dean of the school of medicine at TTUHSC at the Permian Basin.